Reading in the English Literary Heritage-response to Shakespeare Essay

Write an essay, which focuses on the character of Lady Macbeth as presented in act five, scene one and the scenes leading up to the murder of King Duncan. In act five, scene one the audience sees one of the many facets of Lady Macbeth’s complex character as she is seen to be sleepwalking, while being carefully observed by her waiting gentlewoman and a doctor of physic. Her gentlewoman introduces this deranged behaviour, when she says, â€Å"Lo you, here she comes. This is her guise and, upon my life, fast asleep.† There are many possibilities to be explored that could be found to be the impetus bringing Lady Macbeth to sleepwalk. The first being that in Shakespeare’s time a person found to be sleepwalking meant that evil spirits and demons possessed them. Lady Macbeth played a forceful role in the scheming, leading up to the murder of Duncan and was heavily involved in the event itself. In act two, scene two; exasperated with Macbeth, Lady Macbeth takes the daggers to smear Duncan’s blood on his servants’ faces. The sight of Duncan’s blood has had a profound effect on her and in act five, scene one this becomes apparent when she says in her sleep, † Yet who would have thought the old man to have had so much blood in him.† In saying this line she is remembering and reflecting on the moment of when she placed the bloody daggers next to the guards. She is thinking about how much Duncan bled. The image of Duncan’s blood on the daggers and on her hands has stuck in her mind and is plaguing her thoughts, so much so that she is desperate to be cleansed. The crime is lying very heavily on her conscience and her heart and she longs to be cleansed of the blood, which is symbolic of her guilt at the deeds she has committed. While in a frantic, frenzy she says, â€Å"Out damned spot! Out, I say!† Whilst delivering this line, Lady Macbeth excessively rubs her hands in a washing motion. Although this is not a stage direction in the play, it is implied by the gentlewoman’s line, â€Å"It is an accustomed action with her, to seem thus washing her hands.† This action of Lady Macbeth suggests that her conscience and imagination are deceiving her causing her to have an illusive image of her hands covered in blood. She is trying to erase herself of the guilt she now feels at murdering Duncan. Although in Act two, scene two Lady Macbeth, says to Macbeth, â€Å"A little water clears us of this deed.† By this she means that with water the blood will wash off and they can forget that the murder ever happened. However, in act five, scene one she is distressed because she can’t get rid of the vision of blood and the feeling of guilt. She says, â€Å"What, will these hands ne’er be clean?† This rhetorical question is almost a statement from Lady Macbeth in a state of desperation questioning whether she will ever be able to be rid of the guilt at what she has done. All throughout this scene Lady Macbeth is in a state of mental turmoil and most of her deepest, most private thoughts and feelings are revealed. Subtly this illustrates how men and women in Shakespeare’s time had vastly different roles. Lady Macbeth has no one to talk to with a head full of anxieties, regrets and confusion. She is isolated and alone. Her thoughts about the murder and how distant Macbeth has become are driving her mad, which is manifested by her sleepwalking. Whereas Macbeth’s fears are displayed in act three, scene four at a banquet, when Macbeth is unnerved at his mind’s illusion of Banquo’s ghost. These feelings of Macbeth are shown at an extremely public event, a banquet surrounded by all his lords and important men in society. However Lady Macbeth’s fears are revealed in the private setting of her bedroom. She has to be much more conservative than Macbeth as it is her role to be publicly stable. Macbeth is permitted to expose his true sentiments, because he is king and furthermore because he is a man. In the time before the murder, Lady Macbeth loved life and she and Macbeth had the perfect partnership. They saw each other as equals and were both ambitious and secure in their relationship and their position in society, although Lady Macbeth was continuously striving for more. Despite all this, after the murder they have drifted apart. They no longer control things together and the emotional distance between them means Lady Macbeth fears what her tyrant husband will do next because she feels she no longer knows him as she once did. Evidence of this can be found in the fragmented language she uses when sleepwalking, that echoes her own and Macbeth’s words about past murders: Duncan, Lady Macduff and Banquo. Her tortured imagination peregrinates over past conversations she has had with Macbeth. At first she ponders on the murder of Duncan, â€Å"One, two. Why then ’tis time to do’t.† Which is referring to what Macbeth says to her in act two scene two, just before he goes to carry out the murder, â€Å"I go and it is done. The bell invites me.† Then she turns her attentions to the murder of Lady Macduff and her children, she says, â€Å"The thane of Fife had a wife. Where is she now?† Following this she relives what she says to Macbeth at the banquet in reassurance to convince him that he can’t see Banquo. â€Å"Banquo’s buried; he cannot come out on’s grave.† However, Lady Macbeth continuously goes back to the murder of Duncan, which implies that compared to the other murders she was most affected by it. This is because she was heavily involved so it was when her state of mind and all the different aspects of her life changed suddenly and dramatically. Repeatedly Lady Macbeth restates lines that she said to Macbeth in a desperate attempt to re-establish the connection that she and Macbeth once had. As Macbeth no longer seems to exist for her, she has become extremely isolated and in saying lines such as, â€Å"Come, come, give me your hand.† She is yearning for the security of her own marriage. While sleepwalking, Lady Macbeth carries with her a candle. As suggested in her gentlewoman’s line, â€Å"She has light by her continually, ’tis her command.† Lady Macbeth is frightened of darkness and always needs the security of light around her. This may be because Duncan’s murder was committed at night in darkness and she is frightened of his ghost or of being murdered herself in darkness. However it is a strong contrast to the start of the play, Act 1 Scene 5 where she pleads for darkness, so she and Macbeth can murder Duncan. â€Å"Come, thick night, and pall thee in the dunnest smoke of hell, that my keen knife see not the wound it make.† It is also a contrast of the personality and state of mind of Lady Macbeth; at the beginning of the play she is a strong, confident, motivated and ambitious woman and the driving force behind Macbeth. However as the play develops she becomes less assertive, and more unsettled. Lady Macbeth thought that once the murder of Duncan was accomplished and completed, it would be finished and she and Macbeth would become successful rulers of Scotland. She reflects on this thought in act five, scene one, by saying, â€Å"Who knows it, when none can call our power to account?† Nevertheless only one part of this dream of the future has come to life and that is that she and Macbeth are rulers of Scotland. Duncan’s murder was far from the end of that series of events for Lady Macbeth; instead it has provoked lots and changed everything. The sleepwalking portrays this and shows that she is unsettled, maybe because of her unfulfilled dreams. The audience is shown another feature of Lady Macbeth’s character in act five, scene one. Her sentiments are expressed with a simplistic use of language, with the use of prose as opposed to verse. For example, â€Å"Here’s the smell of blood still; all the perfumes of Arabia will not sweeten this little hand. O, O, O.† This uncovers what Lady Macbeth is truly feeling in her heart and head. Her human emotions are also demonstrated about her regret at the amount of bloodshed, and the audience sees her as not just a manipulator but as scared, vulnerable and confused woman. Her gentlewoman says in sympathy for her, â€Å"I would not have such as heart in my bosom for the dignity of the whole body.† The presence of the doctor and the waiting gentlewoman add to the effectiveness of this scene by the way they react to what Lady Macbeth is doing and saying. When the doctor realises what Lady Macbeth is reliving and saying about the murders he is unsure, horrified and can’t make sense of it. Whereas the waiting gentlewoman already knew about the murders from Lady Macbeth’s sleepwalking in the past and she knows she could be in serious trouble if the doctor tells anyone what he has discovered. She says to the doctor, â€Å"Neither to you, nor anyone, having no witness to confirm my speech.† However the doctor and the waiting gentlewoman are both innocent onlookers on the situation and have mixed emotions. Whereas they are both horrified at what they hear, they can’t make sense of it and feel pity for Lady Macbeth and how troubled she is. The doctor says, â€Å"My mind she has mated and amazed my sight.† And, â€Å"The heart is sorely charged.† This all adds to the effectiveness of the scene because it shows a normal person’s reaction to what has happened to Lady Macbeth, which also shows a contrast to the audience between her uneasy and almost insane character and that of a sane, rational person. This enhances Lady Macbeth’s character for the audience. Further more when the doctor says, â€Å"This disease is beyond my practice. More needs she the divine than the physician.† There is a feeling of sadness and sympathy from him. This provokes the same feelings from the audience. In the first half of the play the audience saw Lady Macbeth as a strong, female character, (relative to Shakespeare’s times) and now they see that she has a tyrant of a husband, who has no conscience and she is bearing all the guilt of their actions for both of them. I believe that Shakespeare wanted to affect the audience in this scene and make them have some sympathy for Lady Macbeth. The dramatic function of the presence of the doctor and waiting gentlewoman in this scene is to narrate to the audience the scenes events and explain to them what is happening. The doctor gives detailed descriptions of what is happening, for example, â€Å"Look how she rubs her hands.† It is then the waiting gentlewoman who commentates further and emphasizes the events, and also adding some further information, beyond the scene, such as, â€Å"It is an accustomed action with her, to seem thus washing her hands; I have known her continue in this a quarter of an hour.† This gives the audience additional information about the events, which increases the effect of the scene because it is delving into the reasons of Lady Macbeth’s increasing uneasiness. One could consider that Shakespeare’s dramatic purpose of placing this scene at this point in the play is to show the transformation and variation in Lady Macbeth’s character. Prior to this scene in the play the audience sees Lady Macbeth as a strong, ambitious, female. Throughout act five, scene one Shakespeare reminds the audience of the past events leading up to the murder of Duncan and how Lady Macbeth has come to be so disrupted, unsettled and disturbed. The scene summarizes previous events, while also depicting Lady Macbeth’s state of mind to the audience and showing the transformation of her character. Act five, scene one’s dramatic purpose is to be in a position to be able to be a conclusive scene of the beginning of the plays events, before moving on to the downfall of Macbeth. The opening scene of the play grabs the audience’s attention as three witches appear on stage. The witches would have scared an audience in Shakespeare’s times because they was a strong belief in superstition but nowadays it takes a lot more to scare an audience. In act one, scene one; briefly the witches arrange a meeting with Macbeth on a heath. â€Å"When shall we three meet again? In thunder, lightning, or in rain?† To which the reply is, â€Å"Upon the heath. There to meet with Macbeth.† In act one, scene two Macbeth is instantly introduced as a heroic, strong character by the Captain of a battle, in which Macbeth defeats the rebel enemy Macdonald, personally killing him against the odds. â€Å"For brave Macbeth-well he deserves that name-disdaining fortune, with his brandished steel, which smoked with bloody execution.† Reflecting on this King Duncan sentences a traitor, the Thane of Cawdor and awards this title to Macbeth. â€Å"No more that Thane of Cawdor shall deceive. Go pronounce his present death and with his former title greet Macbeth. What he hath lost, noble Macbeth hath won.† The witches are re-introduced to the audience in act one, scene three, this time on the heath in foul weather, which serves to increase the dramatic effect. They are waiting for Macbeth to come. The witches are evil women, who plan to use their power. As they wait for Macbeth they plot to torment a sea captain whose wife has tormented them, by describing terrible things, which makes the start of the scene quite violently disturbing, with a threatening atmosphere. Macbeth’s arrival is signalled by a drum, â€Å"A drum, a drum; Macbeth doth come.† Says the third witch. As Macbeth enters for the first time in the play, with fellow warrior Banquo, his initial words are, â€Å"So foul and fair a day I have not seen.† Immediately this establishes a connection between Macbeth and the witches, as their lines in the opening scene were, â€Å"Fair is foul, and foul is fair.† Also the witches are called the weà ¯Ã‚ ¿Ã‚ ½rd sisters, and in Anglo-Saxon mythology, weà ¯Ã‚ ¿Ã‚ ½rd sisters were the goddesses of destiny who predicted the future. When Macbeth and Banquo enter they are puzzled as to what these beings are with such a revolting appearance, Banquo describes them, â€Å"So withered and so wild in their attire, that look not like th’inhabitants o’th’earth. Each at once her choppy finger laying upon her skinny lips; you should be women and yet your beards forbid me to interpret that you are so.† What happens next is very significant for the rest of the play. The witches’ prophecy about Macbeth and his future and then at his request, Banquo, † All hail Macbeth, hail to thee, Thane of Glamis. Thane of Cawdor. That shalt be king hereafter.† They predict that Macbeth will have these titles and that Banquo’s descendants will be kings, but he himself will not. â€Å"Thou shalt get kings, though thou be none.† Then refusing to answer Macbeth’s questions the witches vanish in front of Macbeth and Banquo, leaving them shocked, bewildered and discombobulated. The witches come to Macbeth at exactly the right moment and place to shock him. He is fresh from the killings at the battle and his raw ambition is hungry for greater things. The witches introduce these things to him by speaking his innermost thoughts and tempting him with his own aspirations and predilections. Macbeth and Banquo are both left to reflect on what the witches have just said to them and to try to make some sense of it when Ross enters, telling Macbeth of his new title, Thane of Cawdor, â€Å"He bade me, from him, call thee Thane of Cawdor: In which addition, hail most worthy thane, for it is thine.† This shocks Macbeth, as he says, almost accusingly, â€Å"Why do you dress me in borrowed robes?† Then, later in the scene three, Macbeth exposes his initial thoughts in an aside to the audience about the witches’ prophecy and how there moral implications have affected him. Macbeth’s mind is in turmoil, as he battles with his conscience and his desires over how he should behave in response to the witches’ prophecy. He is disturbed and horrified at the thought of killing Duncan, as they have great respect for each other, but he desperately wants to become king, that is his deepest ambition and desire, â€Å"Why do I yield to that suggestion, whose horrid image doth unfix my hair and make my seated heart knock at my ribs against the use of nature?† However he resolves with himself to accept the future and the changes it will bring, â€Å"If chance will have me king, why chance may crown me without my stir.† Whereas Banquo uses the imagery of clothes to elucidate Macbeth’s, â€Å"rapt†. He says, â€Å"New honours come upon him like our strange garments, cleave no to their mould, but with the aid of use.† During act one, scene four, Duncan reveals and announces that his own son, Malcolm is to be heir to the throne. This irritates and appalls Macbeth; if Duncan had not named Malcolm as his heir, the thanes would have elected the next king after Duncan’s death, and as Macbeth is a honoured warrior, there was a possibility he would have been elected. The audience sees another facet to Macbeth’s character when in an aside he says about his annoyance, â€Å"That is a step on which I must fall down, or else o’erleap, for in my way it lies. Stars, hide your fires, let not see my black and deep desires, the eye wink at the hand.† These lines really seal Macbeth’s evil intentions and it is maybe what makes him decide, definitely that he will be king, whatever the consequences are for others and him. When the audience first sees Lady Macbeth in act one, scene five, she is reading Macbeth’s letter in which his meeting with the witches is described to her, â€Å"They met me in the day of success, and I have learned by the perfectest report they have more in them than mortal knowledge.† In reading the letter further, Lady Macbeth learns of the witches’ prophecy and that the first, that Macbeth will become Thane of Cawdor has been fulfilled almost right away. Previously Macbeth has demonstrated his disgust at the thought of the murder of Duncan and the consequence and repercussions it would have. After reading the letter Lady Macbeth reinforces these emotions and thoughts by saying in her first soliloquy, â€Å"Glamis thou art, and Cawdor, and shalt be what thou art promised.† Lady Macbeth knows her husband is ambitious and passionate about his dreams of kingship, but she also knows and feels that he is too fair and conscientious about what is wrong and what is right. She says, â€Å"I do fear thy nature it is too full o’th’milk of human kindness to catch the nearest way.† We know Lady Macbeth and Macbeth are great partners, who share everything, and know each other inside- out, and this is confirmed in Macbeth’s letter when he refers to her as, â€Å"My dearest partner of greatness.† However, taking this into account Lady Macbeth realises that to become queen of Scotland and to realise her own and Macbeth’s dreams she will have do or sacrifice anything to get this. She says, â€Å"What thou wouldst highly, that wouldst holily; wouldst not play false, and yet wouldst wrongly win.† Saying this it appears as though Lady Macbeth’s naked ambition is almost stronger than her husbands. She seems to disregard morals in order to get what she wants and has unbelievably strong willpower and determination. Once she has decided Macbeth will be king, then she starts to introduce supernatural forces and the idea of inviting in evil spirits to help her succeed. â€Å"That I may pour my spirits in thine ear and chastise with the valour of my tongue.† It is when Lady Macbeth is told of Duncan’s plans to visit the castle that her ambition and wickedness bloom and become very apparent. She knows that this is her chance to seize the moment and facilitate Macbeth’s future role as king of Scotland. In her second soliloquy she summons up her evil spirits in the form of magic to assist her with her murderous plans for Duncan. She refers to a raven, which is a bird, seen as an evil omen and then she says, â€Å"Come, you spirits that tend on mortal thoughts, unsex me here and fill me from the crown to the toe top full of direst cruelty; make thick my blood, stop up th’access and passage to remorse.† In saying this, it is clear that she no longer just wants to be an ambitious and dominant woman, her desire is to become evil personified, pitiless and with no sense of morals. She says, â€Å"Come to my woman’s breasts and take my milk for gall, you murd’ring ministers.† She is saying that she wants her breasts to be full of poison, rather than â€Å"the milk of human kindness.† Which is what she described Macbeth as having. Lady Macbeth closes her speech with triumph, summoning night, death and hell. She pleads for a disguise for the crime that she and Macbeth will commit. â€Å"Come, thick night, and pall thee in the dunnest smoke of hell, that my keen knife see not the wound it makes, nor heaven peep through the blanket of the dark.† Lady Macbeth almost seems to have changed from an ambitious, forceful woman into an evil woman, harbouring evil spirits and thoughts. However in reality she is still a mortal woman, whose actions will cause her to suffer great consequence and remorse. As Macbeth enters, Lady Macbeth greeting echoes that of the witches. â€Å"Great Glamis, worthy Cawdor, Greater than both by the all-hail hereafter.† This suggests that she now has formed a connection with the dark side and that evil spirits really are deeply entwined in her thoughts and actions. The instant she starts a conversation with Macbeth, she makes it clear what is going to happen to Duncan that night, â€Å"O never shall sun that morrow see.† She is implying in her words that after that night Duncan will never see sunlight again, because he will be dead. Lady Macbeth instructs Macbeth to, â€Å"Look like th’innocent flower, but be the serpent under’t.† She makes an analogy, in which she compares Macbeth to be a serpent, which is biblically an evil creature. Then she takes control of the situation and Macbeth with a strong sense of purpose and character that is ruthless, â€Å"To alter favour ever is to fear. Leave all the rest to me.† When Duncan arrives at the castle in scene six Lady Macbeth confidently leads him inside and to his death with a sense of triumph. â€Å"Your servants ever have theirs, themselves, and what is theirs in count to make audit at your highness’ pleasure, still to return to your own.† However during this time, leading up to the murder Lady Macbeth continuously has to reinforce her plans, courage and strong will onto Macbeth, who shows reluctance in accepting it. At the start of scene seven, Macbeth is seen to be agonising relentlessly with his conscience over killing Duncan and the consequences it will incur. He wrestles with his conscience, saying, â€Å"If it were done when ’tis done, then ’twere well it were done quickly.† Then he has a change of heart saying, â€Å"He’s here in double trust: First, as I am his kinsman and his subject, strong both against the deed; then as his host, who should against his murderer shut the door, not bear the k nife myself.† This private reasoning continues until, finally Lady Macbeth appears and puts a stop to it. At first Macbeth refuses to do the murder, saying, â€Å"We will proceed no further in this business.† However his efforts are wasted on her as she turns angrily on him and we see her become a manipulating, strong willed woman again. Immediately she turns things around on Macbeth and simply points out that he implied that the murder was the only thing to do. â€Å"Was the hoe drunk? Hath it slept since? And wakes it now to look so green and pale at what it did so freely? From this time, such I account thy love.† She also says that if he is taking back all the things he said, she will assume that that is true about how strongly he loves her. This would hurt Macbeth and also come as quite a surprise as they have such an intense and loving relationship. Then more effectively she torments Macbeth about his masculinity by calling him a coward. â€Å"Live a coward in thine own esteem.† She knows Macbeth well enough to know that will upset him because he is publicly known as a heroic warrior, however it doesn’t get the reaction she wants as he points out to her that he is merely a man. I dare do all that may become a man; who dares do more is none.† Furthermore Lady Macbeth makes the ultimate taunt to persuade her husband to kill Duncan by saying she would kill their child. â€Å"I have given suck and know how tender ’tis to love the babe that milks me: I would, while it was smiling in my face, have plucked my nipple from his boneless gums and dashed the brains out, had I sworn as you have done this.† In saying this Lady Macbeth is playing her womanliness against Macbeth’s manliness by saying she would make the ultimate sacrifice to keep the promise he has made. She makes the point that she once was a mother, and she could remember the overwhelming love she felt for her child, but she would have given it all up to make Macbeth king. Lady Macbeth is also clever in realising she needs to use violent, disturbing, grotesque imagery for Macbeth as a shock tactic to convince him to murder Duncan, as this night is their perfect opportunity. At this point Macbeth offers no resistance to his wife’s strength and force over him, as he knows he will not overcome her determination and extreme assertiveness, â€Å"Bring forth men-children only, for thy undaunted mettle should compose nothing but males.† He only questions what should happen if they were to fail, which she replies in an extremely optimistic, self assured and almost over confident manner, â€Å"Who dares receive it other, as we shall make our griefs and clamour roar upon his death!† The plan for the murder is organised and in act one, scene seven Macbeth leaves to complete it saying, almost wearily and sadly, â€Å"I go and it is done. The bell invites me. Hear it not, Duncan, for it is knell that summons thee to heaven or hell.† In act two, scene two, exhilarated by alcohol and anticipation Lady Macbeth awaits her husband to confirm that the murder is done. â€Å"That which hath made them drunk, hath made me bold; what hath quenched them, hath given me fire.† She has drugged Duncan’s bodyguards, but is afraid that Macbeth may have been too cowardly to carry out the murder. â€Å"I have drugged their possets, that death and nature do contend about them, whether they live, or die.† It is then, when Lady Macbeth reveals her single weakness up until this point, which is why she couldn’t or wouldn’t murder Duncan herself, â€Å"Had he not resembled my father as he slept, I had done’t.† This is another facet of her character shown, as we start to see her humane side exposed and vulnerable. Following this Macbeth returns to Lady Macbeth to say he has completed the murder in a terrible state of remorse and fear of what will punish him of the crime he has just committed. â€Å"Wherefore I could not pronounce ‘Amen’? I had most need of blessing, and ‘Amen’ stuck in my throat.† He is obsessively panicky because he cannot say ‘Amen’. It is then, that Lady Macbeth regains control of the situation and transforms into an iron willed woman again in order to hold Macbeth together. She says to him in an ironic and impatient manner, dismissing his hallucinations of a voice crying he had murdered sleep, â€Å"These deeds must not be thought after these ways; so, it will make us mad.† It is then when she sees that Macbeth has brought the bloody daggers back from the scene of the murder that she implicates herself and gets further involved with the murder; Macbeth refuses to return the daggers so she says, â€Å"Give me the daggers. The sleeping and the dead are but as pictures; ’tis the eye of childhood that fears a painted devil. If he do bleed, I’ll gild the faces of the grooms withal, for it must seem their guilt.† From this point onwards Lady Macbeth and Macbeth’s relationship starts to change as they drift apart emotionally and physically. Their personas are dramatically reversed as Lady Macbeth who was once an iron willed, passionate, ambitious woman becomes extremely deranged and depressed. Her character develops and changes throughout the play as she is transformed from an ambitious, powerful woman to someone is full of regret and with a heart full of foreboding, which lies very heavily on her conscience. Paradoxically, Macbeth’s characteristics, his strong sense of morals and fairplay and a clear conscience are replaced with a tyrant personality and where little or no remorse at the taking of other people’s lives.

I Know Why the Caged Bird Sings

Lee 1 Nadia Lee English 2 Mr. List 19 January 2013 I Know Why the Caged Bird Sings By: Maya Angelou 1. Before I chose this poem, I was thinking about choosing a couple of other ones when I finally realized that this poem caught my eye the most. I Know Why the Caged Bird Sings helped me realize the benefits and consequences from both sides in life. I found this poem in Google under the category that said â€Å"poems that talk about life†. If you read this poem and take it literally, than it will mean nothing, but if you take it to the next level by comparing it to life, than it will mean so much more. . The author of this poem is Maya Angelou who is a famous well known poet throughout the world. Angelou is an African American who went through so much pain during her youth years. Angelou was just a child when African Americans were being discriminated by whites. When she was eight years old, her mother’s boyfriend, Freeman, raped and sexually abused Angelou. She then told her brother who later took Freeman to court finding him guilty. After he was released from jail, one of Angelou’s uncles murdered Freeman later turning Angelou into a mute.Angelou stayed mute for five years, but within those years was when she developed a passion for books and literature. Throughout the years, Angelou has written many poems such as On the Pulse of Morning and Just Give Me a Cool Drink of Water ‘Fore I Diiie. 3. I Know Why the Caged Bird Sings was chosen as the title of this poem because it talks about how people in life struggle through so many things and that we must hold on to hope in order to keep moving on in life. Angelou put this as the title because it represents who she is and Lee 2 what she went through.She knows why the caged bird sings because she is the caged bird. The title tells us that this poem is going to talk about what Angelou felt and her experiences of her youth. The caged bird and Angelou have so many things in common. Both have b een restricted and need to be let free. This title does reflect the overall theme of this poem. It actually explains so much more of the theme rather than the poem itself. I don’t believe that this poem needs an alternative title. It tells the reader everything already. It already touched my heart and I believe that it’s the perfect title. . I would say that this poem would be a lyrical type of poem. This poem expresses a lot of feelings and emotions that allows the reader to understand what the poet felt. This poem expresses the feelings of being alone, locked up and wanting to be free. I believe that the speaker of this poem is someone who is like a bystander. This bystander is observing one bird that is caged and another that is free. The situation is that the caged bird is trying to be like the free bird by spreading out its wings, but can’t because of its oppressor making it impossible for him to fly. 5.This poem is written in free verse meaning that it con tains no definite meter or a pattern of the rhyme scheme. It is divided into six stanzas containing four to eight lines within each stanza. Each line does not contain a lot of words and the poet makes it short and simple. 6. â€Å"The free bird leaps / on the back of the wind / and floats downstream / till the current ends / and dips his wings / in the orange sun rays / and dares to claim the sky. † This is an example of imagery where Angelou allows us to imagine a bird flying in the sky. The poet did not include any sounds devices in this poem.This poem contains many personifications and metaphors such as â€Å"But a caged bird stands on the grave of dreams† (metaphor). Angelou uses the caged bird and the free bird as an analogy that talks about her life. 7. This poem talks about two birds, one that is free and another that is locked up. Angelou talks about how the free bird is independent and does whatever it wants while the caged bird just Lee 3 hops around in his c age singing. She is comparing the lives of these two birds. The theme is about Angelou’s struggle to survive and how she grew up in a cruel world.The first stanza talks about how the free bird flies endlessly in the sky and floats down a stream relaxing. This stanza is telling us how there are people in this world who are not afraid of anything and can do whatever they please. To them, there is nothing that is troubling them and life is perfect. The second and third stanza then switches over to the caged bird and talks about how he does not have enough space to walk around. The only thing this bird can do is to sing about his rage. These stanzas tell us that there are those like Angelou who don’t possess what others have and uses the only thing they have.The only thing that they possess is hope and without hope there is nothing at all. The fourth stanza talk about how the free bird is provided with everything it needs. If you compare this to life than it tells us how t here are others who are spoiled and well cared for. The fifth stanza talks about how the caged bird only has his voice because everything he used to have are now gone. Even though some people don’t have what they need, they still make the best of what they have left. The last and final stanza repeats the third stanza. All we can do is to dream and wish for what we want while living life the best we can. I Know Why the Caged Bird Sings Lee 1 Nadia Lee English 2 Mr. List 19 January 2013 I Know Why the Caged Bird Sings By: Maya Angelou 1. Before I chose this poem, I was thinking about choosing a couple of other ones when I finally realized that this poem caught my eye the most. I Know Why the Caged Bird Sings helped me realize the benefits and consequences from both sides in life. I found this poem in Google under the category that said â€Å"poems that talk about life†. If you read this poem and take it literally, than it will mean nothing, but if you take it to the next level by comparing it to life, than it will mean so much more. . The author of this poem is Maya Angelou who is a famous well known poet throughout the world. Angelou is an African American who went through so much pain during her youth years. Angelou was just a child when African Americans were being discriminated by whites. When she was eight years old, her mother’s boyfriend, Freeman, raped and sexually abused Angelou. She then told her brother who later took Freeman to court finding him guilty. After he was released from jail, one of Angelou’s uncles murdered Freeman later turning Angelou into a mute.Angelou stayed mute for five years, but within those years was when she developed a passion for books and literature. Throughout the years, Angelou has written many poems such as On the Pulse of Morning and Just Give Me a Cool Drink of Water ‘Fore I Diiie. 3. I Know Why the Caged Bird Sings was chosen as the title of this poem because it talks about how people in life struggle through so many things and that we must hold on to hope in order to keep moving on in life. Angelou put this as the title because it represents who she is and Lee 2 what she went through.She knows why the caged bird sings because she is the caged bird. The title tells us that this poem is going to talk about what Angelou felt and her experiences of her youth. The caged bird and Angelou have so many things in common. Both have b een restricted and need to be let free. This title does reflect the overall theme of this poem. It actually explains so much more of the theme rather than the poem itself. I don’t believe that this poem needs an alternative title. It tells the reader everything already. It already touched my heart and I believe that it’s the perfect title. . I would say that this poem would be a lyrical type of poem. This poem expresses a lot of feelings and emotions that allows the reader to understand what the poet felt. This poem expresses the feelings of being alone, locked up and wanting to be free. I believe that the speaker of this poem is someone who is like a bystander. This bystander is observing one bird that is caged and another that is free. The situation is that the caged bird is trying to be like the free bird by spreading out its wings, but can’t because of its oppressor making it impossible for him to fly. 5.This poem is written in free verse meaning that it con tains no definite meter or a pattern of the rhyme scheme. It is divided into six stanzas containing four to eight lines within each stanza. Each line does not contain a lot of words and the poet makes it short and simple. 6. â€Å"The free bird leaps / on the back of the wind / and floats downstream / till the current ends / and dips his wings / in the orange sun rays / and dares to claim the sky. † This is an example of imagery where Angelou allows us to imagine a bird flying in the sky. The poet did not include any sounds devices in this poem.This poem contains many personifications and metaphors such as â€Å"But a caged bird stands on the grave of dreams† (metaphor). Angelou uses the caged bird and the free bird as an analogy that talks about her life. 7. This poem talks about two birds, one that is free and another that is locked up. Angelou talks about how the free bird is independent and does whatever it wants while the caged bird just Lee 3 hops around in his c age singing. She is comparing the lives of these two birds. The theme is about Angelou’s struggle to survive and how she grew up in a cruel world.The first stanza talks about how the free bird flies endlessly in the sky and floats down a stream relaxing. This stanza is telling us how there are people in this world who are not afraid of anything and can do whatever they please. To them, there is nothing that is troubling them and life is perfect. The second and third stanza then switches over to the caged bird and talks about how he does not have enough space to walk around. The only thing this bird can do is to sing about his rage. These stanzas tell us that there are those like Angelou who don’t possess what others have and uses the only thing they have.The only thing that they possess is hope and without hope there is nothing at all. The fourth stanza talk about how the free bird is provided with everything it needs. If you compare this to life than it tells us how t here are others who are spoiled and well cared for. The fifth stanza talks about how the caged bird only has his voice because everything he used to have are now gone. Even though some people don’t have what they need, they still make the best of what they have left. The last and final stanza repeats the third stanza. All we can do is to dream and wish for what we want while living life the best we can.

The Characteristics of Partnership

Partnership is one of the most popular types of enterprise in Vietnam. A partnership is an unincorporated association of two or more individuals to carry on a business for profit. Many small businesses including retail, service, and professional practitioners, are organized as partnerships. Like the other types, partnership contains its own features and characteristics which help to differentiate itself from the others. First of all, in terms of the number of partners, there are no less than two partners who are joint owners of the company and carry out business.In addition to general partner, there may also be limited partners. General partner is required to be individual and will be liable to all obligations of the partnership with his entire property, while limited partner will be liable to debts of the partnership only to the extent of their capital contributed to the partnership. It should be pointed out that there are restrictions on the rights of general partners. General part ner cannot be sole proprietor or general partner of another partnership, unless otherwise agreed by remaining general partners.Besides, general partner is not allowed to act on his own behalf or on behalf of other persons in implementing the same business activities of the partnership for the benefit of himself or other. Also, general partner is not permitted to transfer a part or whole of his capital contribution to others. It is necessary to mention that a partnership will be given legal status from the issuing date of the certificate of business registration and that partnership is not entitled to issue any type of securities. The next characteristic of partnership is limited life.The life of a partnership may be established as a certain number of years by the agreement. If no such agreement is made, the death, inability to carry out specific responsibilities, bankruptcy, or the desire of a partner to withdraw automatically terminates the partnership. Every time a partner withdra ws or is added, a new partnership agreement is required if the business will continue to operate as a partnership. With proper provisions, the partnership's business may continue and the termination or withdrawal of the partnership will be a documentation issue that does not impact ongoing operations of the partnership.Unlimited liability is another feature relating to partnership. This is the prominent feature of partnership that the liability of each partner is not limited to the amount invested but his private property is also liable to pay the business obligations. Partners may be called on to use their personal assets to satisfy partnership debts when the partnership cannot meet its obligations. If one partner does not have sufficient assets to meet his/her share of the partnership's debt, the other partners can be held individually liable by the creditor requiring payment.There must be agreement between the parties concerned. This is the most important characteristics of partn ership. Without agreement partnership cannot be formed. But only competent persons are entitled to make a contract. There are some provisions contained in the partnership agreement. These are determined clearly before the commencement of business. But it differs from business to business. These documents may be written or oral. But it must be written so that disputes may be settled according to the provisions of agreement.Moreover, in terms of capital contribution, it is stated that general partner and limited partner are required to make capital contribution fully and promptly as committed. General partner who does not make capital contribution so fully and promptly that cause losses to the company must compensate for those losses. If a limited partner does not contribute capital fully and promptly as committed, deficiency in the capital contribution will be considered as his/her debt to the company; in this case, such a limited partner may be expelled from the partnership by a dec ision of the partners’ council.By contrast, with a full capital contribution, partners will be granted a certificate of capital contribution. Another characteristic that belongs to partnership is the division of profits or losses. It is not essential that all the partners must share the losses also. There may be a provision in the partnership deed that a particular partner or partners shall not bear losses. The profit is arrived at after providing for salaries to the partners and interest on capital, if agreed and stated in the agreement.That last but not least feature of partnership is about the business management. Firstly, it is specified that all general partners are entitled to act as legal representative of the partnership in carrying out business activities. Any restriction applicable to general partners in relation to conducting day-to-day business activities of the partnership will be effective to the third party if this party is informed. Secondly, general partners will agree on division of their duties in relation to management and running of the company.If a business activity is carried out by several partners, the decision will be adopted on the principle of majority. Additionally, the partnership will not be liable to any activity that is conducted by general partner and outside the scope of business activities of the partnership, unless otherwise agreed by the partners. Thirdly, the partnership can open one or several accounts with a bank. The partners’ council will appoint one partner who is required to deposit and withdraw money from those accounts.Lastly, chairman of the partners’ council, director or general director of the partnership is obligated to: manage and run the day-to-day business operation as a general partner; convene and organize meetings of the partners’ council, sign decisions of the partners’ council; make arrangement of business activities and coordination between partners, sign decisions p romulgating internal rules and other working regulations of the partnership, retain fully and honestly all accounting books, invoices and other documents in pursuant to the laws, act on behalf of the partnership in working with state authority, play the part as a plaintiff or defendant in lawsuits or other commercial disputes as well as other duties as stipulate in the company charter.

Value Added Tax in European countries Research Paper

Value Added Tax in European countries - Research Paper Example It was evident that if there was ever going to be an efficient single market in Europe, a neutral and transparent turnover tax system was required which ensured tax neutrality and allowed the exact amount of tax to be rebated at the point of export. This created tax is known as Value Added Tax (VAT). Drawing reference to Economy Watch (2011), it described Value Added Tax (VAT) as being a special type of indirect tax in which a sum of money is levied at a particular stage in the sale of a product or service. Initiated for the first time April 10, 1954 in France by Maurice Laure; the joint director of tax authority, the VAT is designed to eliminate any problems which may be caused by double taxations. The VAT is intended to be charged whenever there is some added value to raw materials. The taxpayers on the other hand, will get credit for the amount of tax paid off at the stages of procurement. For further clarification, the European Commission Taxation and Customs Union declares a tax able person as any individual, partnership, company or whatever which supplies the taxable goods and services in the course of business. However, if the annual turnover of this person is less than a certain limit (the threshold), which differs according to the member State, the person does not have to charge VAT on their sales. The VAT due on any sale is a percentage of the sale price but from this the taxable person is entitled to deduct all the tax already paid at the preceding stage. As such, double taxation is avoided and tax is paid only on the value added at each stage of production and distribution. In this way, as the final price of the product is equal to the sum of the values added at each preceding stage, the final VAT paid is made up of the sum of the VAT paid at each stage. The value added tax system deals with these problems quite efficiently. As VAT is imposed on value addition - at every single stage - there is no incidence of cascading. In this way, the final consum ers bear the burden of paying value added tax. This system involves absolute transparency at every stage of taxation, thereby making the tax system quite comprehensible and simple (Economywatch.com) For the purpose of exports between community and non-member countries, no VAT is charged on the transaction and the VAT is already charged on the transaction and the VAT already paid on the inputs of the goods for export is deducted – this is an exemption with the right to deduct the input VAT, also called ‘zero-rating’. That means there is no residual VAT contained in the export price. However, as far as imports are concerned, VAT must be paid at the moment the goods are imported so they are immediately placed on the same footing as equivalent goods produced in the community. Taxable people registered for VAT will be able deduct this VAT on their next VAT return. The system has proven to be effective in avoiding problems caused by double taxation of goods and service s and also problems with the conventional sales tax. Compared to the VAT, the Sales tax does not provide for input tax credit, which means that the consumer may pay tax on an input that has already been previously taxed. This scenario should be better able to explain the VAT system in Europe. This scenario will take a rate of 10% 1. The Manufacturer pays $1.10 for raw materials.

Intelligence Challenges in Homeland Security Essay

Intelligence Challenges in Homeland Security - Essay Example Government and policy maker should consider intelligence community activities are welcomed just as civil liberty is respected. Moreover, the acceptance of the intelligence community activates ease the tension created through their course of duties. Public debate and civil society’s participation also ensure that people understand the reason and purpose of the intelligence community.2 The security of a country depends on the success or failure of the intelligence community. Intelligence community has grown over for more than 30 years and has evolved with the advent of new technology to support the functions of government in the provision of services to the citizens. Therefore, a balance between civil liberty and intelligence community ensures that people are secured with all that government offers, and their life is protected.3 The current governments are formed through a democratic process and, therefore, intelligence community need to respects the values of democracy to deceive it activities with dictatorship. One of the important measures that balances civil liberty with the intelligence community is the institutionalization of civil society.4 I agree that civil liberties hinder efficient collection of intelligence information from individuals and corporations. The right of liberty guarantees people from surveillance by people and government without their knowledge. Therefore, to ensure that security is guaranteed by the government agencies civil liberties and intelligence community activities should strike a balance. I concur that the engagement of civil societies and public debate ensures that people understands the roles of the intelligence community and thus offers assistance rather that threatening on civil suits. However, public participation may post a threat to national security as not all information is supposed to be shared, it is essential to make people aware of the need for intelligence collection. I agree that the intelligence

Conversations with History Essay Example | Topics and Well Written Essays - 500 words - 1

Conversations with History - Essay Example Michael Scheuer. Interview with Michael Scheuer Looking at the interview with Mr. Scheuer, it is relevant to say that the answers as his response to all the questions asks came from a point of view of a military whose loyalty lies on the organization and to his country and not to the welfare of the whole world. . According to his belief, if there are things to be learned from the methods being used during the war, this is to kill the enemy as a whole. It has been an experience in their organization that killing them one by one would just only provoke the rest of the enemy. In a war, he considers civilian victims and dead militaries are but just a body counts and a price of the war. For him, during the time of war, enemies must be destroyed by all means as well as the allies and this has been the way of the US to be able to remain in power for 30 years. With regard to the civilians who would be affected and could be killed in the war, Scheuer took it as a part of the war, killing civi lians to be able to win the war or either not to go to war at all.

Hot house song Essay Example | Topics and Well Written Essays - 250 words

Hot house song - Essay Example There is trading depicted where the four; Dizzy Gillespie, Parker, George and Stan Levy change turns from trumpet to piano then to trumpet as the drums are being played at the background. The role of the guitar is to give a fast tempo to the melody as the drums gives the transition sound change from trumpet to piano. The piano and trumpet are the main instruments giving the harmonic structure of the melody. The sequence of events in the melody begins with Dizzy Gillespie and Charlie Parker introducing the melody at the same time as Stan Levy plays drums in the background. Charlie Parker and Dizzy Gillespie play alto sax and trumpet in turns respectively. Later George Shearing play the piano alone after the trumpet and finally the melody is concluded by Dizzy and Parker. Dizzy appear to be the main soloist. His participation is impressive since he shows facial expressions implying he is filling the melody within himself. The solo is successful in the melody since his facial expression attracts the audience attention and interest.

THOMSON REUTERS CURRENT STRATEGIC REVIEW Essay Example | Topics and Well Written Essays - 2250 words

THOMSON REUTERS CURRENT STRATEGIC REVIEW - Essay Example The study analyses the strengths, weaknesses, opportunities and threats of the company and also discusses on the strategic measurements of the company that has the led the company build up its value chain attracting and sustaining customers across the world. The major strategic options for the company could thus be determined from the study of this company as found to be essential strategic measures for the success of a business. Introduction: The Thomson Reuters organization was formed from two powerful brands- Reuters in Europe and Asia, and Thomson in US and Canada- and aims to present the professional markets across the world with Intelligent Information intended to generate Knowledge to Act. Thus the organization focuses to serve its customers across the world involving the established strengths of both these brands. Powering the market across the entire globe is the primary goal of the company. Thus the organization focuses on creating and maintaining simplicity, offer insight through autonomous information and substance to facilitate resolutions and are the reliable association between individuals, dealings and information. Innovation is the primary objective of the organization. The organization intends to deliver excellent service to its customers through its products and improve the reliability, stability and quality of the operations of the company (Thomson Reuters: Knowledge to Act n.d.). The performance of the company over the years has been recognized and rewarded by several publications and organizations across the globe. Considering the recent times, the company’s AlertNet Climate was chosen as an Official Honoree in the Green Category by the 16th Annual Webby Awards. The Technical Analyst Award for 2012 was also won by Thomson Reuters News Analytics. AlertNet received the recognition for the Best Designed Site and the Best Video Journalism was achieved by The Egyptian Revolution. The company had also been awarded for their charity functi ons. Their data and technology, law, and accounting were equally recognized and awarded in the recent times (Awards & Recognition 2013). Thus it can be observed that the company over the years has considered effective measures towards achieving its significant position in the industry as reflected through such awards and recognitions. When strategic review of an organization is concerned, it is referred to the understanding of the strategic measures of an organization enabling it to perform successfully in the long run. It is generally difficult for an organization to consider measures that would prove to be effective in the long run. Organizational strategies need to be considered as a continuous process for an organization to discuss measures among the organizational members for plans that would be executed in the short as well as in the long terms. This would essentially focus on the objectives of an organization that need to be achieved. The internal and external factors of an o rganization are largely responsible in affecting and influencing the organizational strategies. Also, the organizational culture is a significant factor that affects the strategies considered by an organization (Hodge 2012). The present study focuses on Thomson Reuters and considers a strategic review of the organization thus discussing about the current strategic

Wars and Attempts at Territorial Expansion are Often the Result of Essay

Wars and Attempts at Territorial Expansion are Often the Result of States' Rational Efforts to be Secure - Essay Example Different nations presented different strategies and reasons for war. The reasons for engagement in war and expansion of territories for different nations were diverse with the first reasons being the security dilemma. However, other nations engaged in war and expansion effort for different reasons. According to analysis of different wars that transpired within different areas of the world, the major reason for efforts to expand territories and take part in warfare was purely to make the nation or kingdom have more security compared to its enemies. This was considered a long-term assurance of safety, since the majority of the leader feared countries that had enormous population, since the populace had the capacity to provide large armies and other warfare equipments. Security was considered the most imperative aspect for any leadership mainly in the yester years since no permanent boundaries had been in place, as evident today where boundaries have been predetermined. Various wars an d expansion efforts were captured in an attempt to make certain countries secure from their enemies. The Crimean wars can be presented as one of the wars that involved expansion of territories in a bid to improve security for the attackers. ... Therefore, Russia was obtaining a solid foundation although Ottoman still possessed the greater parts of Balkan. Ottoman’s performance in the acquisition and expansion of the territories had been on a downward trend at that moment after episodes of significant conquers. The Russians were considered the protectors of the holy place for the Christians in the Ottoman’s territory. The French assisted in combating conflicts between the Christian and Orthodox thus obtaining regards from the Turks (Badem 64). In this period, Russia resolved to utilizing tension as an instrument to acquire authority over Constantinople together with the advantage it had regarding, contact with the Mediterranean. The move significantly cause panic for the French and Britain who profoundly objected the move since they had developed rivalries with Russia. They viewed the move as an upset of authority within the region. Soon after the refusal of the demands, war broke out in various areas around th e Turkish Empire. In response, Turkey established war with Russia thus leading to the large war between the two regions in the warfare of Oltenitza (Badem 99). Consequently, Russia overpowered Turkish forces through the utilization of the famous shell guns. However, the victory was short-lived with the affirmation of warfare on Russia by the Turkish allies mainly the French and the British. Turk gained further support from Austria since they had considerable opposition to the expansion plans that Russia depicted through subsequent conquers (Badem 65). Therefore, the three realized the objective of stumping Russia out of Balkans. In addition, the powers resolved to

Richard III Essay Example for Free

Richard III Essay Richard then feels that he has been a burden on his mother all these years and perhaps out of his contempt and disdain for his own life. He decides to become and anti-hero, now the audience has come sympathy for him to some extent. We hear the troubles he faced in his childhood and his relationship with his mother, now the audience begins to question his sincerity. Richard possesses a coveted trait of motivation, he has the incentive and determination to carry out his plans carefully and cautiously as he executes his victims perfectly. His killing of his two nephews is an example, Richard lures them into the Tower very slyly: If I may counsel you, someday or two Your highness shall repose you at the Tower Richard lures his nephews, who are innocent and fall into a false sense of security, Richard acts like he is loving and is looking out for them. Richard is so motivated in his quest for power and claim of the throne because he is a villain and was rejected from his mother and this can cause him becoming bitter and resentful. He does not use this charm and incentive personality to make positive changes to his life but he does not stop at anything to get to the throne. The ways that the other characters portray Richard inevitably have an effect on the audience. As Richard is constantly said to be villainous and is seen in a censorious light, it is very likely that the audience will be persuaded by the conviction of other characters. He is seen pessimistically by other characters, Anne describes him as: Thou lump of foul deformity. This shows she has no respect for him. Queen Margaret holds nothing but abhorrence and detestation for Richard: A murderous villain, and so still thou art. Richard was also described by his mother as a toad. The disapproving behaviour towards Richard by many characters in conjunction with Richards pitiless actions, pushes the audience to feel the same way. Shakespeare has created a villain and anti-hero with numerous traits, personalities and fai ades which make it hard to distinguish who this villain is. The villain is obviously Richard III. Through his soliloquies, the audience is able to have an insight to how insensitive, cruel and vindictive Richard is. His deformity and family background may have caused Richard to become very bitter and consequently cause him to resent life and became a villain. His actions cannot be excused because they are not morally accepted in society. I believe Shakespeare has regurgitated other villain from his previous plays and deformed this one. He shows a love hate relationship, we are as the audience is impressed by Richard as he has the ability to charm and manipulate his victims. His ruthlessness leaves no vulnerability to make him human and suffer the consequences of his actions, we hate him yet we are fascinated by him. Richards scheming helped him come into power by other people failing to prevent him. Shakespeare created a character that we can only believe is fictional has he is so captivating. Richard can be compared to Hitler because he succeeded through his extremist personality. William Shakespeare created a complex, controversial and multi-personality character which will be remember for years to come.

Ethical Issue of Life Support Machine

Ethical Issue of Life Support Machine Directions: Read the case study provided. In essay style, apply and discuss the questions listed below: In the case of the patient R.J his autonomy has been taken away from him, as he is no longer able to make any decisions on his own. His ability to make his own choices for his health are gone he has lost all control of how he would want to be treated. Even before he was brain dead I would question if he really ever had autonomy with the decision to have the surgery – was he made aware of the complications that could happen? Was he given the proper consultation and was he ever asked if he had a family member who had problems with anesthesia? As for justice, I feel that it will never be served because my own belief is that you cannot get the person back to what you knew them as before. They have changed forever and so have you. No amount of money would fix this problem for most. I feel justice in this case will never be gotten. The family has lost trust in the medical field they do not trust what is being told to them because they feel they have been lied to from the start. They feel this could have been prevented with some extra care. Could this have been prevented with just a few more questions from the anesthesiologist and should the patient have brought up the family history of complications during surgery? Unfortunately surgery is risky and accidents happen and patients are informed of the risks but how much information can a person take in while someone is talking to then in medical jargon? As Anderson and McFarlane point out: â€Å"Beneficence is perhaps one of the strongest guiding ethical principles of health care professionals.† (2010, p.________) This being said, I do believe the doctors were responsible for what happened to this patient. They are the experts and they have the knowledge to handle difficult situations. Did the fact that the member has the extra weight cause the physician to not be able to intubate the member? Did the physician ever call a code or ask for assistance? This is all information that needs to be available in order to see if the members rights were protected. I personally worked in surgery for many years and saw many mishaps. I have seen surgery on the wrong patient and the wrong body part. I believe we should implement more resources to protect the patient that goes into surgery but time is money and rushing through the process is what causes mistakes. The non-maleficence in this case is that the member had the right to be protected from harm, this was not the case for this patient nor his family. His life will be forever negatively changed and so will his family’s. The mistrust the family has with the medical system will make this very sad case even worse as they will begin to see the health care system as the enemy. The family has been affected by the non-maleficence as they too have been hurt emotionally and probably financially, spiritually and in ways we can never imagine. It is obvious the physician did not set out to do this to the patient but the fact is that it did happen and he is responsible as he was unable to intubate. This is a risk of surgery and patients should be advised more than not that surgery should be the last resort. The family needs time to grieve. They have lost a very valuable member of their family very unexpectedly. I would first begin to assess what they understand about his condition. I would gently tell them what his prognosis is and I would also have a family meeting with a spiritual leader of their choice, a social worker, a psychiatrist and also all the physicians involved. I would ask the family to say what they needed to say to get their feelings out, their concerns, frustrations and anger. I would make sure before the meeting was over that they understood the health of the patient and that there was no hope for recovery. I would have them explore what type of person he was and if he would want to live this way. If this is what he would want then they would move to find him a place to live long term. If this was something he would not have wanted then offer them some choices such as taking him of life support and letting him die with dignity. This would be a very difficult decision a nd this would have both a positive and negative as nothing will be resolved except for the comfort of the patient. The family will probably never get a positive outcome. Page four paraphrase- this is good http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/EthicsStandards/CodeofEthics.aspx 5.  Professionalism Each nurse needs to understand the responsibilities and concerns that are integral to the nursing profession. Working with a team of health care professionals to provide care for patients in need requires a discipline and internal and external composure that stays steady throughout the day. Knowledge, expertise, team work and compassion are hallmarks of professionalism in nursing that I try to express in my practice. â€Å"The nurse in all professional relationships, practices with compassion and respect for the inherent dignity, worth and uniqueness of every individual. Unrestricted by considerations of social or economic status, personal attributes, or the nature of the health problem.† (American Nurses Association, n.d.) A nurse has to take up a great deal of responsibility and must prove worthy of it. Everything from responsible patient care, to monitoring delicate equipment to which the patient is hooked, to responsible handling of medication is the nurse’s lot. A professional nurse is one who takes this responsibility very seriously and understands the consequences of mistakes. I take responsibility for my patient from the moment I am given report and until I leave the hospital. I am a professional to my patients and to me that means being present. Doing for them what they need to be comfortable and safe. I am there for them not for the social talk or the coffee break. I am there to take care of the patient and if I can help them in any way that’s what I do. 6. Mission and Philosophy of the Division of Nursing A. Describe what aspects of the mission and philosophy you feel are evident in the coursework in the RN-BSN program. My own words no citing The mission and philosophy I feel as evident in our coursework over the last few years have been the exploration of cultures and beliefs of other cultures. We have learned from each other our differences but also our similarities. I have learned to be tolerant when I did not agree with some of my cohorts especially when we did religious classes and the tension in the class room escalated from friendly to hostile. I learned to just listen and to explain part of my religion but to also keep an open mind to the beliefs of others. I also felt they needed to understand that this was a Catholic university and to be respectful of the courses that were presented as this was part of the curriculum. We all knew what courses we were to take coming into this program and if there was a conflict of interest that should have been introduced at the beginning of the BSN program not while the class was being taught by a highly respected professional. The course definitely made me a more critical thinker and made me learn not to accept answers on a superficial level, it helped me to look into matters with a more educated and focused approach to what was being presented to me as fact. Health is wholeness derived from the harmonious internal interaction of the body, mind, and spirit and the harmonious balance between person and environment. This statement is very much how I viewed the courses that were offered to me at part of the Immaculata program, they all taught us about the harmonious internal interaction of the body. We had many courses that helped us explore the holistic approach to taking care of the patient and therefore we learned a lot about ourselves. This helped us grow to become more patient centered and to focus on the task at hand and to become aware of the person we were taking care of whether they can communicate with us or not. I enjoyed the courses that were offered and I will say that I grew with each course that I completed, I felt better about my nursing career and I truly felt like I had grown as a person and as a nurse. This was a big change for me as before I took this BSN program I did not think it would help me, I actually looked at this journey of getting my BSN as something that I had to do in order to keep my job. I began fully to see that program became so impotent to who I was as a person and it became so important to who I am that I am going to miss going to class and I am going to miss my fellow students. I am especially going to miss some of the teachers who I have come to respect. B. What has been your experience with the culture of faculty interactions with students? My experiences with the faculty and their interactions with students have been positive overall. So many of the courses we took were geared towards accepting other cultures and beliefs. The class had a nice mixture of different beliefs and they were all respected by the faculty. We felt free to discuss our differences without feeling we were being judged for being different. I also feel this is an individual and personal finding and it may not reflect on how others in the class perceived the faculty and its interactions with the students. In some cultures the, students are more accustomed to seeking help from peers than from the professor. This may be because the student feels self-conscious approaching an authority figure, because seeking extra assistance is viewed as inappropriate â€Å"hand-holding,† or because asking for help is associated with weak or desperate students, and is thus stigmatizing. While soliciting help from peers can be helpful under some circumstances, there are times when peers are not in a position to provide helpful feedback. Students enter your classroom with expectations and interpretations shaped by their own cultural conditioning. Your expectations regarding appropriate classroom behavior, faculty and student roles, good writing, etc., may not be theirs. This is a product not only of cultural differences but of variations in the teaching styles of different faculty members. Even students who are familiar with the U.S. educational system have to adapt to the differing expectations of their various professors. Thus, it is helpful to all your students to spell out as concretely and specifically as possible – on your syllabus, in class, on tests and assignments, etc. – What your expectations are in regard to issues such as the following: A percentage breakdown of the graded components of your course not only helps students make reasonable time-allocation decisions (see Time Allocation); it also alerts international students to the fact that their course grade will be determined on the basis of multiple graded assignments (exams, papers, lab reports, designs, etc.) Seeing all the course requirements and their weighting can be particularly helpful for students from cultures in which only end-of-term examinations really â€Å"count understand what is expected of them in a college classroom, it is helpful not only to spell out clearly what you expect of them (see Make Your Expectations Explicit) but also to provide models of the kinds of work you want them to produce andthe kinds of skills you want them to cultivate. Seeing illustrations of good work can help students identify skills they need to develop. You might, for example: Provide examples of outstanding student work (e.g. outstanding designprojects, stage sets, engineering solutions, papers) and discuss with your students what makes them effective. This can help students (a) identify the elements of good work as they apply to particular assignments within particular domains, (b) become more conscious of these elements in their own work, and (c) understand what you, as an instructor, are expecting of them. Models of excellent student work can also help students think more broadly about an assignment, consider alternative approaches, etc. Model the kinds of discussion and debate behaviors you want students to develop. Some faculty members, for example, invite a colleague to class to debate an issue. Watching two faculty members engaged in an animated debate can help students understand how to participate in a respectful but intellectually challenging exchange. It also illustrates the dynamic nature of academic discourse.

Mechanism Of Action Of Warfarin Biology Essay

Mechanism Of Action Of Warfarin Biology Essay Warfarin is an anticoagulant medication that is used to prevent thrombosis (clots) and embolism in many disorders. Warfarin activity has to be monitored by frequent blood testing for the International Normalized Ratio (INR). Warfarin is a synthetic derivative of coumarin, a chemical found naturally in many plants it decreases blood coagulation by interfering with vitamin K metabolism. Mechanism of Action of Warfarin Warfarin is vitamin K antagonist that produce its anticoagulant effect by interfering with the cyclic interconversion of vitamin K and its 2,3 epoxide (vitamin K epoxide). Vitamin K is a cofactor for the posttranslational carboxylation of glutamate residues to ÃŽÂ ³-carboxyglutamates on the N-terminal regions of vitamin K-dependent proteins (Whitlon, et al., 1978; Fasco, et al., 1982) .123456 These coagulation factors (factors II, VII, IX, and X) require ÃŽÂ ³-carboxylation for their biological activity. Coumarins produce their anticoagulant effect by inhibiting the vitamin K conversion cycle, thereby causing hepatic production of partially carboxylated and decarboxylated proteins with reduced procoagulant activity.78 In addition to their anticoagulant effect, the vitamin K antagonists inhibit carboxylation of the regulatory anticoagulant proteins C and S and therefore have the potential to exert a procoagulant effect. In the presence of calcium ions, carboxylation causes a conformational change in coagulation proteins91011 that promotes binding to cofactors on phospholipid surfaces. The carboxylation reaction requires the reduced form of vitamin K (vitamin KH2), molecular oxygen, and carbon dioxide, and is linked to the oxidation of vitamin KH2 to vitamin K epoxide. Vitamin K epoxide is then recycled to vitamin KH2 through two reductase steps. The first, which is sensitive to vitamin K antagonists,123 reduces vitamin K epoxide to vitamin K1 (the natural food form of vitamin K1), while the second, which is relatively insensitive to vitamin K antagonists, reduces vitamin K1 to vitamin KH2. Treatment with vitamin K antagonists leads to the depletion of vitamin KH2, thereby limiting the ÃŽÂ ³-carboxylation of the vitamin K-dependent coagulant proteins. The effect of coumarins can be counteracted by vitamin K1 (either ingested in food or administered therapeutically) because the second reductase ste p is relatively insensitive to vitamin K antagonists (Fig 1). Patients treated with a large dose of vitamin K1 can also become warfarin resistant for up to a week because vitamin K1 accumulates in the liver and is available to the coumarin-insensitive reductase. Pharmacokinetics and Pharmacodynamics of Warfarin Warfarin is a racemic mixture of two optically active isomers, the R and S forms in roughly equal proportion. It has high bioavailability,1920 is rapidly absorbed from the GI tract, and reaches maximal blood concentrations in healthy volunteers in 90 min after oral administration.1921 Racemic warfarin has a half-life of 36 to 42 h, circulates bound to plasma proteins (mainly albumin), and accumulates in the liver where the two isomers are metabolically transformed by different pathways.22 The dose-response relationship of warfarin is influenced by genetic and environmental factors, including a recently identified common mutation in the gene coding for one of the common cytochrome P450 enzymes (2C9), the hepatic enzyme responsible for oxidative metabolism of the warfarin S-isomer.2324 This mutation likely contributes to the variability in dose response to warfarin among healthy subjects.25 In addition to known and unknown genetic factors, various disease states, drugs, and dietary fac tors can interfere with the response to warfarin. The anticoagulant response to warfarin is influenced by pharmacokinetic factors, including drug interactions that affect the absorption or metabolic clearance of warfarin, and pharmacodynamic factors that alter the hemostatic response to given concentrations of the drug. Variability in anticoagulant response also occurs as a result of inaccuracies in laboratory testing, patient noncompliance, and miscommunication between patient and physician. Other drugs may influence the pharmacokinetics of warfarin by reducing GI absorption or by disrupting its metabolic clearance. For example, the anticoagulant effect of warfarin is reduced by cholestyramine, which impairs its absorption, and is potentiated by drugs that inhibit warfarin clearance through stereoselective or nonselective pathways.252627 Stereoselective interactions affect oxidative metabolism of either the S-isoner or R-isomer of warfarin.2627 Inhibition of S-warfarin metabolism is more important clinically because this isomer is five times more potent as a vitamin K antagonist than the R-isomer.2627 Clearance of S-isomer warfarin is inhibited by phenylbutazone,2829 sulfinpyrazone,30 metronidazole,31 and trimethoprim- sulfamethoxazole,32 each of which potentiates the effect of warfarin on the prothrombin time (PT). In contrast, drugs such as cimetidine and omeprazole that inhibit clearance of the R-isomer have only moderate potentiating effects on the PT in patients treated with warfarin.272833 Amiodarone inhibits the metabolic clearance of both the S-isomer and R-isomer and potentiates the anticoagulant effect of warfarin.34 The anticoagulant effect is inhibited by barbiturates,32 rifampicin,34 and carbamazepine,32 which increase its metabolic clearance by inducing hepatic mixed oxidase activity. Although long-term alcohol use has a potential to increase the clearance of warfarin through a similar mechanism, consumption of even relatively large amounts of wine was shown in one study29 to have little influen ce on PT in subjects treated with warfarin. For a more thorough discussion of the effect of enzyme induction on warfarin therapy, the reader is referred to a critical review (Table 2 ).35 The pharmacodynamics of warfarin are subject to genetic and environmental variability. Hereditary resistance to warfarin occurs in rats36 as well as in human beings.3738 Patients with genetic warfarin resistance require doses fivefold to 20-fold higher than average to achieve an anticoagulant effect. This disorder is attributed to altered affinity of the receptor for warfarin since the plasma warfarin levels required to achieve an anticoagulant effect are increased. Two mis-sense mutations in the factor IX propeptide have been described394041 that cause bleeding without excessive prolongation of PT. When affected individuals are treated with coumarin drugs, factor IX activity decreases to about 1 to 3%, while levels of other vitamin K-dependent coagulation factors decrease to 30 to 40% of normal. These mutations are uncommon and have been estimated to occur in Subjects receiving long-term warfarin therapy are sensitive to fluctuating levels of dietary vitamin K,4243 which is provided predominantly by phylloquinone in plant material.43 The phylloquinone content of a wide range of foodstuffs has been listed by Sadowski and associates.44 Phylloquinone acts through the warfarin-insensitive reductase reaction.45 Important fluctuations in vitamin K intake occur in both apparently healthy and sick subjects.46 Increased intake of dietary vitamin K sufficient to reduce the anticoagulant response to warfarin42 occurs in patients on weight-reduction diets consuming green vegetables or receiving vitamin K-containing supplements, and in patients treated with IV supplements containing vitamin K. Reduced dietary vitamin K1 intake potentiates the effect of warfarin in sick patients treated with antibiotics and IV fluids without vitamin K supplementation and in states of fat malabsorption. Hepatic dysfunction potentiates the response to warfarin through im paired synthesis of coagulation factors. Hypermetabolic states produced by fever or hyperthyroidism increase warfarin responsiveness, probably by increasing the catabolism of vitamin K-dependent coagulation factors.4748 Drugs may influence the pharmacodynamics of warfarin by inhibiting synthesis or increasing clearance of vitamin K-dependent coagulation factors or by interfering with other pathways of hemostasis (Table 3 ). The anticoagulant effect of warfarin is augmented by the second-generation and third-generation cephalosporins, which inhibit the cyclic interconversion of vitamin K,4950 by thyroxine, which increases the metabolism of coagulation factors,48 and by clofibrate, through an unknown mechanism.51 Doses5253 of salicylates > 1.5 g/d also augment the anticoagulant effect of warfarin,54 possibly because these drugs have warfarin-like activity. Acetaminophen has also been reported to augment the anticoagulant effect of warfarin,52 although this contention has been challeng ed (see below). Although heparin potentiates the anticoagulant effect of warfarin, in therapeutic doses, it produces only slight prolongation of the PT. Drugs such as aspirin,55 nonsteroidal anti-inflammatory drugs,56 high doses of penicillins,5758 and moxolactam50 increase the risk of warfarin-associated bleeding by inhibiting platelet function. Of these, aspirin is the most important because of its widespread use and prolonged effect.59 Aspirin and nonsteroidal anti-inflammatory drugs can also produce gastric erosions that increase the risk of upper-GI bleeding.58 The risk of clinically important bleeding is heightened when high doses of aspirin are taken in combination with high-intensity warfarin therapy (INR, 3.0 to 4.5).5560 In two studies, one study61 in patients with prosthetic heart valves and the other study62 in asymptomatic individuals at high risk of coronary artery disease, low doses of aspirin (100 mg/d and 75 mg/d, respectively) were also associated with increased rates of minor bleeding when combined with moderate-intensity and low-intensity warfarin anticoagulation. The mechanisms by which erythromycin63 and some anabolic steroids64 potentiate the anticoagulant effect of warfarin are unknown. Sulfonamides and several broad-spectrum antibiotic compounds may augment the anticoagulant effect of warfarin by eliminating bacterial flora and aggravating vitamin K deficiency in patients whose diet is deficient of vitamin K.65 Wells and associates66 performed a critical analysis of articles reporting possible interaction between drugs or foods and warfarin. Studies were assigned to one category if the interaction was considered highly probable, to a second category if interaction was probable, to a third level if judged possible, and to a fourth level if doubtful. Of 751 citations retrieved, pertinent results from 172 original articles are summarized in Table 3. Strong evidence of interaction was found for 39 of the 81 different drugs and foods appraised; 17 potentiate warfarin effect, 10 inhibit, and 12 produce no effect. Many other drugs have been reported to either interact with oral anticoagulants or alter the PT response to warfarin,6768 but convincing evidence of a causal association is lacking. In a case-control study,52 low to moderate doses of acetaminophen (nine or more tablets per week) were reported to be associated with excessively prolonged INR values. The presence of a causal association bet ween acetaminophen use and potentiation of a warfarin effect is uncertain. The article52 was supported by an editorial,53 but has been challenged by personal experiences (case series) cited in two letters6970 and by the results of a prospective study71 in normal volunteers. However, until more information is presented, it would be prudent to monitor the INR more frequently when acetaminophen is used in this quantity by patients during warfarin therapy. Indeed, it would be reasonable to monitor the PT more frequently when any drug therapy is added or withdrawn from the regimen of a patient treated with an oral anticoagulant. DRUG INTERACTIONS: Your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any drug, vitamin, or herbal product without checking with your doctor or pharmacist first.Warfarin interacts with many prescription, nonprescription, vitamin, and herbal products. This includes medications that are applied to the skin or inside the vagina or rectum. The following interactions listed do not contain all possible drug interactions. The interactions with warfarin usually result in an increase or decrease in the blood-thinning (anticoagulant) effect. Your doctor or other health care professional should closely monitor you to prevent serious bleeding or clotting problems. While taking warfarin, it is very important to tell your doctor or pharmacist of any changes in medications, vitamins, or herbal products that you are taking.This drug should not be used with the following medications because v ery serious interactions may occur: imatinib, mifepristone.If you are currently using any of these medications listed above, tell your doctor or pharmacist before starting warfarin.Aspirin and aspirin-like drugs (salicylates) and nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen, naproxen, celecoxib) may have effects similar to warfarin. These drugs may increase the risk of bleeding problems if taken during treatment with warfarin. Carefully check all prescription/nonprescription product labels (including drugs applied to the skin such as pain-relieving creams) since the products may contain NSAIDs or salicylates. Talk to your doctor about using a different medication (such as acetaminophen) to treat pain/fever. Low-dose aspirin and related drugs (such as clopidogrel, ticlopidine) should be continued if prescribed by your doctor for specific medical reasons such as heart attack or stroke prevention. Consult your doctor or pharmacist for more details.Many herbal medicati ons have blood-thinning or blood-clotting effects, and some may directly affect warfarin. Tell your doctor before taking any herbal products, especially bromelains, coenzyme Q10, cranberry, danshen, dong quai, fenugreek, garlic, ginkgo biloba, ginseng, goldenseal, and St. Johns wort, among others.This medication may interfere with a certain laboratory test to measure theophylline levels, possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist

the scarlet letter :: essays research papers

The Scarlet Letter By Nathaniel Hawthorne   Ã‚  Ã‚  Ã‚  Ã‚  The Scarlet Letter is a story that shows a love that cannot be. â€Å"Mother,† said little Pearl, â€Å"the sunshine does not love you. It runs away and hides itself, because it is afraid of something on your bosom. It will not flee from me, for I wear nothing on my bosom yet!† This quotation is how I see the love that cannot be. The sunshine is the love of a man (Arthur Dimmesdale) and it does just what Pearl says - it runs and hides itself from the scarlet letter.   Ã‚  Ã‚  Ã‚  Ã‚   This love must be hidden because of practical reasons; such as Roger Chillingworth who is her husband is still alive. He knows about his wife and Arthur and he is plotting revenge on Arthur. With Roger in Boston he would get in the way of them having an open relationship and he would destroy their true love.   Ã‚  Ã‚  Ã‚  Ã‚  Arthur and Hester’s love cannot exist because of personal reasons as well. Hester wears the scarlet letter, so Arthur can’t be with her or it might destroy his reputation. Also, if he were to be with her, the people of his church could not look up to him for their spiritual guidance. The final reason to keep these lovers apart is societal. The Puritan belief in New England during the middle of the seventeenth century would not have tolerated any type of union between Arthur and Hester. The strict codes of conduct would destroy any way for them to be alone. Their only opportunities to be alone are chance encounters in the forest, but then it would seem as if they were going to see the black, mysterious man that represents evil in this book. Because of all these reasons, The Scarlet Letter is a story about a love that could not be.

Jarok as a Traitor :: Star Trek Defector Essays Papers

Jarok as a Traitor A creator of a web page has good intentions to display to the viewer the correct information, but there is no way to tell if the creator gives an accurate representation of the information. In the episode "The Defector", Jarok does not appear to be a traitor through his actions, but the way he represents himself clearly makes him a traitor. A traitor, as defined by Webster's Collegiate Dictionary, is one who betrays another's trust or is false to an obligation or duty. A defector is defined as one who leaves a situation often to go over to a rival one. During the course of the episode, Jarok is a traitor to the Romulans, the Federation, and his daughter, although he is labeled in the title of the episode as a defector. During the episode, Jarok physically joins with the Federation, which can lead one to believe he is a defector. He may have crossed over for the good of everyone, but he betrayed his country at an ideological level. He gave information to the Federation, including details of the Romulan fleet, technology, and offensive. "Jarok said that he had seen reports, fee receipts, and work orders for the construction of a military base." (Smith 30 Jan. 1996) He, also, stole a ship and claimed he had no other option, but there were, most likely, other options he could have resorted to. Tomalak, the head of the Romulans remarked at the end of the episode, " You see, Picard, after we dissect your enterprise for every precious bit of information, I intend to display its broken hull in the center of the Romulan capitol as a symbol of our victory. It will inspire our armies for generations to come. And serve as a warning to any other traitor who would create ripples of disloyalty." ("The Defector" 1 4 Jan. 1990) The Romulans planted misinformation knowing Jarok might betray their trust. Jarok believed he had valid information, which placed even greater value on these top secrets he shouldn't have revealed to the Federation. When one obtains information from a web page, the information may not be the truth. After betraying his own country, he could have come over to the rival to act as a defector; instead he represented himself as a traitor to the Federation. By using a false name, it seemed he wanted to conceal his true identity to the Federation.

Newborn Exam

The government initiatives to reduce junior doctors’ hours within the NHS Plan (DH 2000) have increased the call for midwives to expand their traditional role and take on some of the tasks that in the past have mainly been carried out by junior doctors (Kings Fund 2011). Having been working within the community setting as a midwife for the past three years I was interested in extending my role in order to provide more holistic care for my caseload of clients and their babies.Holistic care for mothers, babies and their families is highly recommended within the midwifery profession and is known to provide an improved experience for women (Changing Childbirth (DOH 1993a) NMC 2012, NICE 2006). The Newborn and Infant Physical Examination (NIPE) is one element of the UK National Screening programme and is offered to all parents for their baby within 72 hours of birth and then repeated again at 6 weeks of age, usually by their GP.This role is one of the tasks that has been highlighte d where midwives can expand their role (Marshall & Raynor 2010). The trust where I work has recently introduced community clinics where parents can take their baby in order to have the newborn examination performed, therefore allowing early discharge home from the unit enabling early family bonding. With this in mind I commenced the Newborn and Infant Physical Examination course.Screening has been used within the NHS for many decades and is a process that enables the health professional to highlight healthy members of the population that could potentially have a health related problem (UK National Screening Committee 2008). The NIPE is a head to toe examination that will enable a practitioner to detect in an apparently healthy baby any abnormality that can then be referred onto the appropriate professional for further investigation.This can then improve the newborns future health by providing early intervention and prevention of further complications (DOH 2009). It particularly focu ses on the eye, heart, hips and testes in the male infant. The importance of these particular areas is of great significance to the baby’s future health. An undetected congenital cataract may lead to the child being blind in that eye. A missed heart defect may not be diagnosed until the parents present with a very unwell or even dead infant.If developmental dysplasia of the hip is not treated early enough following birth it could lead to several episodes of major surgery or even disability in the future. Bilateral undescended testes can lead to problems with future fertility. There are many issues surrounding the NIPE that are argued about within the literature Green and Oddie (2008) question whether the NIPE provides the population with and improvement to overall health or if it just gives the parents reassurance that could in the future be proved wrong, due to the NIPE being a screening tool and not a diagnostic test.Within the content of this essay I will be critically ana lysing the NIPE and some issues around this topic focusing particularly on the examination of the hips. Since being a midwife, and a mother, I have always found this part of the examination most difficult to watch someone perform as it appears to be uncomfortable for the baby. Therefore on commencing the course I have been aware of the discomfort it appears to give the newborn and also the distress this could in turn cause for the parents.I will also be looking into the issues regarding which professional is best qualified to be performing the examination and also if there are any benefits or risks as to the place that it is undertaken. When I am performing the examination I will mainly be alone in the community setting either at a children’s centre or within the home environment, so therefore it is imperative that I am aware of any limitations this may present for the baby, parents or me.As previously mentioned there is a growing trend within many obstetric units for midwive s to carry out the NIPE examination. Within the trust that I am based midwifery led clinics are held on the post natal ward and also within the community for the sole purpose of performing the newborn examination. Bloomfield et al (2003) discussed where the examination should take place and found differing opinions. The benefits of being in hospital were noted to be that medical back up was available and it was more convenient for further immediate referral process.Community examinations were thought to be more likely to enable the parents to ask questions and mention concerns due to the relaxed environment. Following the Maternity Matters report (DOH 2007) advocating that women should have a greater choice for place of birth the home birth rate has increased and is continuing to do so. It is therefore ideal for community based NIPE facilities so that women do not have to attend hospital at all following a home birth.On reflection the examinations that I have witnessed and performed unfortunately seem to have been a way to speed up the postnatal discharge procedure therefore freeing up beds within the unit and not due to providing a more continuous midwifery led experience for the parents and baby as Hutcherson (2010) found. The ideal situation would be to perform the examination on the newborn belonging to the mother you have seen through antenatal care and will be caring for post natally therefore providing continuous care for your personal caseload of clients, as discussed by Baston & Durward (2010).The patient satisfaction and overall job satisfaction in this case scenario would be high for all involved but unfortunately I feel in practice will be a rare occurrence. Eventually I believe that in our trust when there are enough trained midwives within each geographical area the possibility of a midwife performing newborn examinations on babies within the teams’ caseload is possible. This far from being the ideal scenario is the closest it will probabl y get to the holistic care sought after by myself and many other midwives.The EMREN (Evaluation of Midwife Role extension in the routine Examination of the Newborn) study carried out by Townsend et al (2004) looked into aspects of the NIPE one of them being whether a midwife was as capable as a senior house officer when carrying out the NIPE and discovered not only that this was the case but that the mothers satisfaction level may be increased if a midwife performed the NIPE and that also money may be saved by the NHS.Having observed SHO’s, appropriately trained midwives and advanced neonatal practitioners (ANP) performing the NIPE I felt that the midwives and ANP’s communicated far more effectively with both the baby and parents therefore better fulfilling the communication aspect of the competency’s indicated by the UK National Screening Committee (2008). They also provided more detailed information on parenting and public health issues during the examinations which should be an integral part of the NIPE (Baston & Durward 2010).There has been much interest recently into whether pulse oximetry should be part of the newborn screening for congenital heart defects. The UK National Screening Committee is at the present time looking into whether this should be included within the NIPE as part of the screening for congenital heart defects in the newborn. It has been recommended in recent studies and has found to increase the detection rate of congenital heart defects (Ewer et al 2011, Chang 2009). Within our trust I have seen this performed on three ewborns following their NIPE, due to nasal flaring, slight cyanosis and a raised respiratory rate, all have proved to be within the normal range. The saturation monitors are present in the units’ clinic rooms where newborn examinations are performed but the community midwives working in children’s centres or at home do not have access to a monitor. Therefore this could be cause for con cern for parents of babies that are being examined in the community. This then presents the ethical dilemma that newborns are being offered a different aspect within the NIPE depending on where it is carried out.Powell et al (2013) found that parents were happy about having the pulse oximetry screening carried out on their newborn but questions need to be asked if they would prefer to not have it done in favour of the NIPE being performed more conveniently within the community. Ewer (2012) discusses the benefits of introducing pulse oximetry monitoring but without any mention of community based NIPE, or newborns that were born in the home environment. Another concern that I have witnessed and am aware of is not having access to all the antenatal notes of the mother within a community setting.On two occasions the mother has been discharged without the appropriate paper work or has not brought it to the clinic appointment. Obviously within the unit the antenatal and labour notes are e asily accessible, within the community if the mother hasn’t the appropriate information then the parents word must be taken. Having all information relating to the antenatal and interpartum periods is an essential part of the midwives role when performing the NIPE. The practitioner must be aware of antenatal and interpartum occurrences to be able to fulfil the competence set by the UK National Screening Committee (2008).When first undertaking the NIPE’s I found the examination of the hips the hardest part of the procedure, mainly because the baby would quite often cry and struggle a little and this would cause the parents to be distressed and concerned. I also, in the past, as a midwife and mother observing this procedure felt uncomfortable. Having now done a larger amount of these examinations and reading and understanding the relevant literature find them easier to perform. Screening for developmental dysplasia of the hip is based n the fact that if not picked up in the newborn could create the need for major surgical procedures in later life also with a poorer future outcome, Dezateux & Rosendahl (2007). Developmental dysplasia of the hip used to be widely known as congenital dislocation of the hip but has been renamed since the 1990’s. The factors behind this change are that it is now recognised that the condition is not always ‘congenital’ and rarely ‘dislocated’ and more likely to be ‘displaced’, Bracken et al (2012).The definition of developmental dysplasia of the hip is very obscure as there are varying degrees and it quite often develops after birth, overall it describes a disorder where the hip joint is unstable and occasionally dislocated. The hip joint consists of the femoral head, the rounded end of the bone which sits within the cartilage of the socket joint known as the acetabulum. There are thought to be different factors as to why the hip joint becomes unstable. At around seven weeks gestation hip formation has already begun, problems can start to occur then.If the femoral head is wrongly positioned from the start it could result in the formation of a too shallow socket. During pregnancy the hip joint can be affected by external and internal forces, for example oligohydramnios, lack of foetal movement due to foetal conditions, breech presentation (Hurley 2009, McDonald & Jenkins 2008). The incidence of developmental dysplasia of the hip varies in the literature, at birth it is thought to be 1-20 in 1000 but the majority of these stabilize without any treatment within the first few weeks of life, bringing the incidence down to 1-2 in 1000 (Campion & Benson 2007).The incidence is higher in female babies, it is believed due to the female newborn being more susceptible to the maternal hormones therefore the joints are more relaxed, Hurley 2009. It is also more prevalent if a sibling or parent has had developmental dysplasia of the hip, McCarthy et al (2005) and McDo nald & Jenkins. Other factors mentioned by McDonald & Jenkins (2008) include first born infants, multiple gestation and occurring in the left hip more frequently than the right.